Employee Benefits Information

2023 - 2024 Employee Cost (Family Coverage)

• Option 1 Summary Benefits and Coverage
• Option 1 Benefits at a Glance
• Option 2 Summary Benefits and Coverage
• Option 2 Benefits at a Glance
• Option 3 Summary Benefits and Coverage
• Option 3 Benefits at a Glance
• Option 4 Summary Benefits and Coverage
• Option 4 Benefits at a Glance

Administrator and Supervisors

Teacher

Administrative Assistant (Full Time)

Bus Driver

Non Affiliated

Early Childhood Center

Office Assistant, Cafeteria Manager, Truck Driver, Van Driver

Head Custodian, Grounds, Mechanics

General Custodian

Para Educator, Media Para

Election of Benefits - new employees, adding or dropping medical

HAP Member Change Form - all changes to medical coverage

HAP HMO Application - option 3 & option 4 enrollment

HAP EPO Application - option 1 & option 2 enrollment

Dental & Vision - new employees

Dental & Vision Change Form - all changes to dental & vision coverage

Beneficiary Form - new employees & all changes in Life Insurance beneficiaries

HSA Deduction Form - new employee & all changes in Health Savings Account

Students Away

HAP EPO Group Policy

HAP HMO Group Policy

HAP Formulary Drug List

Dental - Coordinated Dental (50/50/50)

Dental - Non Coordinated Dental (100/100/100)

Vision - Administrators, Central Office, Supervisors

Vision - Parapros, Administrative Assistants, Office Assistants, Bus Drivers, Head Custodians

Vision (with Medical) - Community Ed, Grounds, Head Custodians, Mechanics, Teachers

Vision (without Medical) - Community Ed, Grounds, Head Custodians, Mechanics, Teachers

Mechanics, Grounds, Head Custodians, Clasp, CEC

Central Office Support & Technology

Teachers

Administrators and Supervisors

METLIFE SUPPLEMENTAL LIFE INSURANCE

• Enrollment and Change Form
• Statement of Health Form
• Cost and Additional Benefits
• Privacy Notice
• Travel Assistance

Building Administrator

Central Office Administrator

Central Office Support

Community Education Personnel

Bus Driver, Clerk, General Custodian, Para Educator, Media Para, Secretary (Part Time)

Bus Driver, Clerk, General Custodian, Para Educator, Media Para, Secretary (Full Time)

Supervisors

Teachers (Part Time)

Teachers (Full Time)

Grounds and Maintenance

Health Savings Accounts and Other Tax-Favored Health Plans

HSA Brochure

HSA Direct Deposit Form

HSA Mobile App Login

Steps for Using Your HSA

Eligible Expenses with HSA Funds

Authorized 403B Investment Provider List

COBRA Information

Retirement Cash Out Information